Health care plans Flashcards Preview

Psych FA > Health care plans > Flashcards

Flashcards in Health care plans Deck (10)
Loading flashcards...
1
Q

HMO - Health Maintenance organization

A

Restricted to a limited panel of in-network providers, except in emergencies.

Low premiums, copays, and deductibles and low overall cost.

Only covers things that meet established, evidence-based guidelines.

Requires a referral from primary care provider to see a specialist.

HMOs use Capitation - the client pays a fixed predetermined fee and then must receive all their care in network. Companies use HMOs for their low cost often.

2
Q

POS - Point of Service

A

A little more expensive than HMOs, with added benefit that patients can see providers outside of the network at an increased out of pocket costs - higher copays and deductibles.

Requires referral from primary care to see a specialists.

3
Q

PPO - Preferred Provider Organization

A

The most flexible and the highest cost.

Can see doctors in or outside of network.

All services have higher copays and deductibles.

Does NOT need referral to see a specialist.

4
Q

EPO - Exclusive Provider Organization

A

Patients are limited to in-network doctors, specialists, and hospitals, but do NOT require a referral to see a specialist.

5
Q

Capitation

A

Doctors get a set amount for each patient assigned to them for the designated period of time, regardless of how much the patient uses the healthcare system.

6
Q

Discounted fee for service

A

Patient pays for each individual service at a predetermined, discounted rate.

7
Q

Global payment

A

Patient pays for all expense associated with a single incident in a single payment.

Most commonly used for elective surgeries.

8
Q

Medicare

A

for patients over 65, disabled patients, and patients with end stage renal disease.

Part A: Hospital insurance, home hospice care.
Part B: Basic medical bills
Part C: Combo of parts A and B, delivered by private Companies
Part D: Prescription Drugs.

we carE for the Elderly

9
Q

Medicaid

A

Joint federal and state.
For people in poverty.

aiD for the Destitute.

10
Q

Hospice care

A

Available to those on Medicaid and Medicare and most private insurances once life expectancy is less than 6 months.

Patients can get opiates to palliate their pain even though it shortens their life, known as the Principle of Double effect.